2006 Utah Code - 34A-2-110 — Workers\' compensation insurance fraud -- Elements -- Penalties -- Notice.

     34A-2-110.   Workers' compensation insurance fraud -- Elements -- Penalties -- Notice.
     (1) As used in this section:
     (a) "Corporation" has the same meaning as in Subsection 76-2-201(3).
     (b) "Intentionally" has the same meaning as in Subsection 76-2-103(1).
     (c) "Knowingly" has the same meaning as in Subsection 76-2-103(2).
     (d) "Person" has the same meaning as in Subsection 76-1-601(8).
     (e) "Recklessly" has the same meaning as in Subsection 76-2-103(3).
     (2) (a) Any person is guilty of workers' compensation insurance fraud if that person intentionally, knowingly, or recklessly:
     (i) devises any scheme or artifice to obtain workers' compensation insurance coverage, disability compensation, medical benefits, goods, professional services, fees for professional services, or anything of value under this chapter or Chapter 3, Utah Occupational Disease Act, by means of false or fraudulent pretenses, representations, promises, or material omissions; and
     (ii) communicates or causes a communication with another in furtherance of the scheme or artifice.
     (b) Workers' compensation insurance fraud under Subsection (2)(a) is punishable in the manner prescribed by Section 76-10-1801 for communication fraud.
     (3) A corporation or association is guilty of the offense of workers' compensation insurance fraud under the same conditions as those set forth in Section 76-2-204.
     (4) The determination of the degree of any offense under Subsection (2) shall be measured by the total value of all property, money, or other things obtained or sought to be obtained by the scheme or artifice described in Subsection (2), except as provided in Subsection 76-10-1801(1)(e).
     (5) Reliance on the part of any person is not a necessary element of the offense described in Subsection (2).
     (6) An intent on the part of the perpetrator of any offense described in Subsection (2) to permanently deprive any person of property, money, or anything of value is not a necessary element of this offense.
     (7) An insurer or self-insured employer giving written notice in accordance with Subsection (10) that workers' compensation insurance fraud is a crime is not a necessary element of the offense described in Subsection (2).
     (8) A scheme or artifice to obtain workers' compensation insurance coverage includes any scheme or artifice to make or cause to be made any false written or oral statement or business reorganization, incorporation, or change in ownership intended to obtain insurance coverage as mandated by this chapter or Chapter 3, Utah Occupational Disease Act, at rates that do not reflect the risk, industry, employer, or class codes actually covered by the policy.
     (9) A scheme or artifice to obtain disability compensation includes a scheme or artifice to collect or make a claim for temporary disability compensation as provided in Section 34A-2-410 while working for gain.
     (10) (a) Each insurer or self-insured employer who, in connection with this chapter or Chapter 3, Utah Occupational Disease Act, prints, reproduces, or furnishes a form to any person upon which that person applies for insurance coverage, reports payroll, makes a claim by reason of accident, injury, death, disease, or other claimed loss, or otherwise reports or gives notice to the insurer or self-insured employer, shall cause to be printed or displayed in comparative

prominence with other content the statement: "Any person who knowingly presents false or fraudulent underwriting information, files or causes to be filed a false or fraudulent claim for disability compensation or medical benefits, or submits a false or fraudulent report or billing for health care fees or other professional services is guilty of a crime and may be subject to fines and confinement in state prison."
     (b) Each insurer or self-insured employer who issues a check, warrant, or other financial instrument in payment of compensation issued under this chapter or Chapter 3, Utah Occupational Disease Act, shall cause to be printed or displayed in comparative prominence above the area for endorsement a statement substantially similar to the following: "Workers' compensation insurance fraud is a crime punishable by Utah law."
     (c) (i) Subsections (10)(a) and (b) apply only to the legal obligations of an insurer or a self-insured employer.
     (ii) A person who violates Subsection (2) is guilty of workers' compensation insurance fraud, and the failure of an insurer or a self-insured employer to fully comply with Subsections (10)(a) and (b) may not be:
     (A) a defense to violating Subsection (2); or
     (B) grounds for suppressing evidence.
     (11) In the absence of malice, a person, employer, insurer, or governmental entity that reports a suspected fraudulent act relating to a workers' compensation insurance policy or claim is not subject to any civil liability for libel, slander, or any other relevant cause of action.
     (12) In any action involving workers' compensation, this section supersedes Title 31A, Chapter 31, Insurance Fraud Act.

Amended by Chapter 329, 1998 General Session